How Undergrads Make Doctors Wash Their Hands

Doctors and nurses don’t wash their hands as often as they’re supposed to. So we were interested to read about a program at UCLA Medical Center that managed to boost compliance with hand-washing guidelines from 50% to 93%, according to a paper published today in the journal Academic Medicine.

The trick was getting undergrads to volunteer to come lurk in the hospital.

By the time the undergrad program launched about five years ago, UCLA had been trying to improve hand-washing adherence for a while, with mixed results. A program that enlisted nursing staff to conduct peer audits of hand washing led to reports of 100% compliance — despite the fact that “feedback from patients and their family members, as well as from the staff and physicians who had been patients, indicated that not all staff members adhered to the standards.”

About 20 students per year are selected for the undergrad program (described at length here), and they record 700 to 800 observations per month. They look for compliance with hand-washing guidelines, as well as adherence to rules for giving medication and handing-off a patient for surgery (adherence to those measures have improved sharply as well since the program launched).

It’s possible that hospital staff have simply learned to follow the rules when undergrad volunteers are looking over their shoulders. Still, it seems reasonable to infer that the gains measured by the undergrads is, at least to some extent, a reflection of an overall improvement. And the program is cheap — about 0.3 FTE during the first year of the program, which fell to 0.1 FTE by the fourth year.

Comments (4 of 4)

Does hiring an FTE to solve hand hygiene get at the root cause of why staff don't wash theirs hands like they should? I don't think so. The Center for Transforming Healthcare should be releasing their findings from a robust Lean Six Sigma project soon...findings that do get at root causes and do not require hiring or using an FTE.

12:46 pm November 26, 2009

hillary wrote :

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11:13 am November 26, 2009

smart as paint wrote :

while handwashing is hard to criticize (i won't), the problem in the hospital is 90 % filth of the patients and 10 % hand washing. the patients in the last 30 years since i have been in practice are older, sicker, more incontinent, inattentive etc. they are frequently on antibiotic therapy for prolonged periods pushing their flora to a more resistant variety. even the community now is increasingly colo nized with these resistant organisms. things in the hospital can always be improved, but most of these improvements are on the margin and don't move the bell curve of hospital acquired infections.

6:48 pm November 25, 2009

cdiff wrote :

Did the improvement in hand-washing from 50% to 93% at UCLA translate to a decline in nosocomial infection, and by how much?